Brayman, Richard ,-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:•::.: Name First Middle Last Sex
Richard Edward Brayman Male
ti :; Date of Death Age If Veteran of U.S. Armed Forces,
ti :; February 3, 2016 51 War or Dates N/A
1Place of Death Hospital, Institution or
City, Town or Village Town of Moreau Street Address 19 Hilton Drive, South Glens Falls, NY
▪ Manner of Death Natural Cause Accident I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
'i Address a b c _Q , ‘ /
: ;::: Death Certificate Filed District Number Register Number
City, Town or Village Town of Moreau 4562 ,1
❑Burial Date Cemetery or Crematory
February 8, 2016 Pine View Crematorium
❑Entombment Address
❑X Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
I Hold
N
O Date Point of
O. Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:;: Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
▪ Address
94 Saratoga Avenue, South Glens Falls, NY 12803
::; Name of Funeral Firm Making Disposition or to Whom
*3 Remains are Shipped, If Other than Above
Address
Ai
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued f�j Jf to Registrar of Vital Statistics y .l/1 i�-',--
(signature)
District Number y 56,•), Place T oti,i Q f 440 4,e t....,_,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition /11? Place of Disposition Vie, v;t,,! c,fe, ,-Fhr y
2 (address)
W
CO
O (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises JC,fmCi V Sul;irt,S
Z (please print)
W Signature�� ly"�/ j6. Title C-Jc"'�nr
'�' (over)
DOH-1555(02/2004)